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Burne,.County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _0 o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> 0 <br /> N <br /> OWNER (�/�� �t'v /✓ TELEPHONE <br /> M Q� <br /> -71 <br /> w ` <br /> l r ,� / / , / CDO <br /> MAILING ADDRESS ,tee / V A `y / r ,v <br /> CD <br /> ,^, <br /> PROPERTY ADDRESS C//O r`/ <br /> LEGAL DESCRIPTION(see tax receipt) � ��� ��� ` L '�O //_— ` <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ 1 .I C o <br /> TYPE OFPERMIT(S): <br /> FILLING/GRADING CAMPING UNIT 1:1 SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: <br /> u /� <br /> �t N d 3 o X /a- S��uu <br /> d (Home/Cabin;;Commercial Business; Bedroom; Deck; etc.) e ./_ w <br /> 42. <br /> BUILDING CONTRACTOR: 464—f �I ��✓ r/`QCT G��� ' �UJ�� <br /> v <br /> ° <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (AERIAL OR TOP VIEW) O a <br /> M <br /> ?I v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 3 <br /> hA,ll � <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o I� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATIO�7 p1fR1[ HEN <br /> NEEDED. l/ ` ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o p� <br /> CONDITIONS OF PERMIT: 93 <br /> '. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. "�(I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 'A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ,Y/� _7 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER 1n <br /> SETBACK AREA. <br /> 5. <br /> m W 0 0 M a F M <br /> 6. ° 3nm % <br /> m <br /> 'O m C1. fA ° <br /> Z y M O O O <br /> 7. ° nm <br /> —(n : ' E D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myC <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of pp m ° : u, <br /> SCJ i a c : N ; >] <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am w <br /> providing in this ap at'o . I agree to permit county officials charged with administering county ordinances or other o <br /> authorized perso o ha ass a ove de cribed premises at any reasonable time for the purpose of inspection. ,t m o <br /> CD <br /> SIGN HERE ° <br /> ign re f owner or Idi contractor) (date) o <br /> ZONING ADM STR OR ' <br /> Y-clp i led � • 3(n <br /> N(IINr1a 0 a <br /> N 00 <br /> �TOWNSHIP PERMITS MAY BE REQUIRED 01 6 i 0100 <br /> '3THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />